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Surgical creation of a gastric fistula through the abdominal wall, used, e.g., for introducing food into the stomach.
The skin around the tube is inspected for signs of irritation or excoriation and kept clean, dry, and protected from excoriating gastric secretions. Tension on the tube that may cause the incision to widen and allow spillage of gastric secretions on the skin or into surrounding tissues is prevented.
Before the patient is fed, tube patency and position are assessed, and the volume of the remaining stomach contents is measured by aspirating the stomach. If the volume is greater than the amount permitted by protocol or the physician's direction, feeding is withheld. The patient should be placed in high Fowler’s position during feedings, and the blenderized food or formula administered slowly by gravity in the prescribed amount (200 to 500 ml). Encouraging the patient to chew prior to enteral feeding promotes gastric secretions to aid digestion. After feedings and after introduction of medications, the tube is flushed with an adequate amount of water (at least 60 ml). Fluid intake and output (which includes aspirated feeding) should be monitored and recorded.
Assistance is provided with oral hygiene at intervals throughout the day to prevent dryness and parotitis. Both patient and family are taught correct techniques for tube and skin care and for feeding through the gastrostomy tube, for keeping track of intake and output, and concerns to be reported to the primary care provider.